Intraoperative Optimization of Radiocephalic Arteriovenous Fistula Surgery with Contemporary Techniques

Abstract

Background This retrospective study assesses the impact of a standardized intraoperative procedure on radiocephalic arteriovenous fistula (RCAVF) outcomes, combining Transit Time Flow Measurement, papaverine administration, and an external support device. Methods Consecutive RCAVF patients were included at The Hague Medical Center between November 2021 and October 2024. Intraoperative flow rates, maturation rates, and (assisted) patency rates at 6 and 12 weeks, and 6 and 12 months were compared to a contemporary control group from the same center. Maturation was defined as a venous diameter ≥ 4 mm, a flow ≥ 500 mL/min, and a palpable thrill. The number of interventions and per-patient costs of interventions and procedures were also recorded and compared. Results The study compared 43 patients in the intervention group with 59 in a control group. The optimized procedure significantly improved intraoperative flow rates (210 ± 89 mL/min vs. 163 ± 85 mL/min, P = 0.008) and maturation rates at 6 weeks (77% vs. 43%, P = 0.002) and 12 weeks (91% vs. 59%, P = 0.003). Males showed higher overall maturation rates (66% vs. 38%, P = 0.030). However, no significant differences were found in primary patency at 12 months, nor in the average number of interventions per patient. There was a trend toward better assisted patency in the optimized procedure group at 12 months. The intervention group had significantly higher average costs per patient (€5858.77 vs. €4148.89, P = 0.002). Conclusion The optimized RCAVF procedure enhances intraoperative flow and early maturation rates, with the most notable effects in the initial postoperative months. Further research is needed to determine the long-term benefits and cost-effectiveness.